Physical and Psychological Triggers for Attacks in Ménière’s Disease: The Patient Perspective

Meniere’s disease (MD) is a debilitating disease of the inner ear for which the main symptoms comprise vertigo, hearing loss, tinnitus and a sense of fullness or pressure in the ear. Residual and movement-provoked dizziness may also occur between major attacks. High levels of psychiatric comorbidity, disability and reduced quality of life are often reported among people who experience such symptoms [1, 2] . Attacks cannot be prevented, and a great deal of uncertainty and distress exists in relation to when symptoms might occur and what might trigger them. Understanding the patient perspective is particularly relevant to the diagnosis and management of vestibular disorders, as reported triggers of dizziness and vertigo inform the diagnosis of vestibular symptoms [3] , and the treatment of symptoms and related distress often involve lifestyle changes and self-management. It is therefore important for clinicians to be aware of the patient’s frame of reference (i.e. their subjective beliefs, perceptions and experiences) when eliciting information about symptoms and triggers. No previous research in this area has carried out an in-depth investigation specifically focusing on beliefs and views about triggers, or sought to identify whether different perceived triggers are associated with different symptoms. The aim of this study was to carry out an in-depth qualitative exploration of views and beliefs about triggers of symptoms of MD and to relate these to the different types of reported symptoms. Semistructured telephone interviews employing open-ended questions were carried out with 20 members of the Meniere’s Society (a UK-based self-help group for people with dizziness and balance disorders) who had completed screening questionnaires and fulfilled inclusion criteria. These comprised experiencing symptoms of vertigo during the past 12 months, current symptoms of tinnitus, aural fullness and hearing disability, and had received a diagnosis of MD from their doctor. Participants were encouraged to give as much detail as possible of their own experiences and views of the warnings and triggers for any symptoms they considered to be an ‘attack’ of MD. As we were interested in participants’ own perspective, interviews were participant led, and we did not offer participants a definition for the term ‘attack’ or request the discussion of particular symptoms. Data were analysed using inductive thematic analysis supplemented by ground